1. Mary E. Williard, DDS Director, DHAT Educational Program Alaska Native Tribal Health Consortium Superior Health Foundation, Children’s Oral Health Summit NMU Conference Center, Marquette, MI May 17, 2014 DENTAL HEALTH AIDE THERAPIST (DHAT)

2. History of Dental Caries in Alaska Native People 1984 1925 Archeological records show caries rate of ~1% 1928 – 1930’s Studies show lowest caries rate in the world Improved air transportation and dietary changes Prevalence of dental caries in children 2x same aged U.S. children 1999 Vast majority of children have dental caries Price, WA. 1939. Nutrition and Physical Degeneration. 8 th ed. Lemon Grove, CA.

3. Dental Therapists: A Definition Primary oral health care professionals Basic clinical dental treatment and preventive services Multidisciplinary team members Advocate for the needs of clients Refer for services beyond the scope of the dental therapist’s practice.* *SASKATCHEWAN DENTAL THERAPISTS ASSOCIATION WK Kellogg Foundation, http://www.wkkf.org/resource-directory/resource/oral-health-resources/dental-therapists-expanding-care- to-every-community

4. DHAT 2-year Education No Prerequisites Conan Murat, DHAT, standing his ground “A local solution to a local problem”

5. Community-based DHAT as part of a dentist led team

6. “A Review of the Global Literature on Dental Therapists”* *Prepared by: David A. Nash, Jay W. Friedman, Kavita R. Mathu-Muju, Peter G. Robinson, Julie Satur, Susan Moffat, Rosemary Kardos, Edward C.M. Lo, Anthony H.H. Wong, Nasruddin Jaafar, Jos van den Heuvel, Prathip Phantumvanit, Eu Oy Chu, Rahul Naidu, Lesley Naidoo, Irving McKenzie and Eshani Fernando Supported by the W.K. Kellogg Foundation http://www.wkkf.org/news-and-media/article/2012/04/nash-report-is-evidence-that-dental-therapists-expand- access Dental Therapists: Decrease cost of care Improve access to care Provide care safely Public values the role of dental therapists Traditionally 2 years education

7. Research Triangle Institute Clinical Evaluation* Summary of findings Technically competent Providing care safely and appropriately Successfully treating cavities and helping relieve pain for patients without previous access to regular care High patient satisfaction Well accepted in AK tribal villages *“Evaluation of the Dental Health Aide Therapist Workforce Model in Alaska Final Report” Prepared for: W.K. Kellogg Foundation,Rasmuson Foundation, Bethel Community Services Foundation. Prepared by: Scott Wetterhall, MD, MPH, James D. Bader, DDS, MPH, Barri B. Burrus, PhD, Jessica Y. Lee, DDS, PhD, Daniel A. Shugars, DDS, PhD, MPH. RTI International 3040 Cornwallis Road Research Triangle Park, NC 27709. RTI Project Number 0211727.000.001

8. The Journal of Public Health Dentistry, Special Issue: Workforce Development in Dentistry: Addressing Access to Care Spring 2011 Volume 71, Issue Supplement S2 American Association of Public Health Dentistry 11-person academic panel Model curriculum two-year, post-secondary Open access online: http://onlinelibrary.wiley.com/doi/10. 1111/jphd.2011.71.issue-s2/issuetochttp://onlinelibrary.wiley.com/doi/10. 1111/jphd.2011.71.issue-s2/issuetoc Curriculum

9. From ANTHC Consultant Survey of AK Tribal Dental Directors Each DHAT team on average, provides care to 830 patients during approximately 1200 patient encounters (or visits) each year. 700 visits 500 visits Scott and Co. Consulting

10. Tribal revenue as reported by dental directors with DHAT The net annual revenue stream generated by the employer is $125,000-$245,000 after costs (DHAT and dental assistant salary, benefits, travel, supplies, and other costs) with savings of ~$40,000 in avoided travel costs to receive dental care 19 DHATs generate 76 jobs (dental assistants, training program faculty, management, staff) with half of these jobs and the related $9m economic activity in rural Alaska Scott and Co. Consulting, 2011

11. Improved Access and Quality 27 certified DHAT 81 communities in rural AK Over 40,000 people have access Continuity of care Higher level of care possible Dentist working up to their licensure DHAT Aurora Johnson, NZ Educated

12. Demographics of the existing US dental workforce Dentists: 86% White 6.9% Asian/Pacific Islander 3.4 African American 3.4 Hispanic 0.2 American Indian *1 Dental hygienists: >90% non ‐ Hispanic white *2 DHAT:88% American Indian/ Alaska Native * 1. Current Demographics and Future Trends of the Dentist Workforce, Institute of Medicine, The U.S. Oral Health Workforce in the Coming Decade: A Workshop February 9, 2009, Richard W. Valachovic, D.M.D., M.P.H., Executive Director, American Dental Education Association 2. Dental Hygiene at the Crossroads of Change, Environmental Scan 2011 ‐ 2021, Marsha Rhea and Craig Bettles.

13. Education Matters… “Jones cited additional problems with degree creep in nursing: a lack of qualified faculty to teach baccalaureate programs, a decline in workforce diversity, deceased access to health care in rural areas, and a decline in job satisfaction and morale if health care workers feel their skills and knowledge are not fully used.”* Barbara Jones, president of South Arkansas Community College (SouthArk) South Arkansas Community College *“Colleges worry about ‘degree creep’ in health care,” By Ellie Ashford, Published August 10, 2011. Community College Times, American Association of Community Colleges.

14. DHAT Educational Program Address: 4200 Lake Otis Parkway, Ste 204 Anchorage, AK 99508 Mary E. Williard, DDS 907-729-5602 DHAT training is ANTHCsmile on Facebook and twitter website: http://anthc.org/chs/chap/dhs/http://anthc.org/chs/chap/dhs/ Div. of Community Health Services- DHAT education